Cowett R M, Tenenbaum D G, Fatoba O, Oh W
Biol Neonate. 1985;47(3):179-85. doi: 10.1159/000242111.
Refractory hypoglycemia has been reported in an infant receiving glucose infusion via an umbilical artery catheter (UAC) above the celiac axis. To prove the hypothesis that hypoglycemia resulted from direct glucose infusion to the pancreas, 15 term spontaneously delivered lambs were infused with 5.3 +/- 0.1 mg X kg-1 min-1 of glucose via an arterial catheter. In 9 glucose was infused below the celiac, and the glucose production rate (GPR) was derived. After a recovery period, the study was repeated with glucose infused above the celiac. During glucose infusion above the celiac, the plasma glucose concentration was lower than when the infusion was given below the celiac (140 +/- 6 vs. 175 +/- 11 mg/dl, p less than 0.01). There was also a fall in the average GPR (3.7 +/- 0.5 vs. 5.5 +/- 0.8 mg X kg-1 min-1, p less than 0.05). In 6 lambs the study was performed in the reverse sequence (high then low infusion) and no differences were noted in the parameters measured. However, there was a marked heterogeneity in the paired GPR in these lambs. We conclude that direct glucose infusion above the celiac increases glucose delivery to the pancreas. This produces increased insulin delivery to the portal system resulting in suppressed GPR and reduction in plasma glucose concentration. These changes may account for refractory hypoglycemia in infants clinically when glucose is infused above the celiac through a UAC.
据报道，一名通过腹腔干以上的脐动脉导管（UAC）输注葡萄糖的婴儿出现了难治性低血糖。为了证实低血糖是由直接向胰腺输注葡萄糖所致的假设，对15只足月自然分娩的羔羊经动脉导管以5.3±0.1mg·kg⁻¹·min⁻¹的速度输注葡萄糖。其中9只羔羊在腹腔干以下输注葡萄糖，并计算葡萄糖生成率（GPR）。经过恢复期后，重复该研究，改为在腹腔干以上输注葡萄糖。在腹腔干以上输注葡萄糖期间，血浆葡萄糖浓度低于在腹腔干以下输注时（140±6 vs. 175±11mg/dl，p<0.01）。平均GPR也有所下降（3.7±0.5 vs. 5.5±0.8mg·kg⁻¹·min⁻¹，p<0.05）。对6只羔羊按相反顺序进行研究（先高后低输注），所测参数未发现差异。然而，这些羔羊的配对GPR存在明显的异质性。我们得出结论，在腹腔干以上直接输注葡萄糖会增加胰腺的葡萄糖供应。这会导致更多胰岛素进入门静脉系统，从而抑制GPR并降低血浆葡萄糖浓度。当通过UAC在腹腔干以上输注葡萄糖时，这些变化可能是临床上婴儿难治性低血糖的原因。
